Managing Hypertension: Technology Challenges Old Habits
Friday, June 05, 2015 08:39 AM

Are automated office blood pressure measurements the way to go for routine check-ups?  Yes, argues Martin Myers, MD, a cardiologist and researcher.

What's wrong with the standard blood pressure cuff in the physicians' office?

"There's a myth that manual blood pressure -- blood pressure taken with a mercury device and stethoscope -- is accurate in the real world. The overwhelming evidence that in routine clinical practice doctors and nurses don't take manual blood pressure in the office with the same care according to guidelines as has been done in research studies with the result that the studies have shown that on average the blood pressure is about 10/5 mm Hg higher. So if we really wanted to look at what the cutpoint for hypertension in the real world in clinical practice is, it would be 150/95 not 140/90 just because it has been taken so poorly."

Is it just a matter of improving technique?

"The American Heart Association has tried for 5 decades to teach nurses and doctors how to take blood pressure properly. They know how to do it; they just often don't it in busy clinical settings all the time certainly, and often don't do it. Shifting the paradigm to get away from it, what we and others have discovered is that you have to eliminate the human element if you want to get an accurate assessment of blood pressure. The best way of assessing someone's status is the 24-hour blood pressure recording and that involves minimal human involvement. That's the perfect way. But in the office, the way to get around human error, bias, conversation between the observer and patient, and minimize patient anxiety is to use a fully automated device so the patient is alone and it takes multiple readings."

Some experts have seriously written that office blood pressure is so bad we shouldn't be doing it anymore. If the automated office blood pressure does away with the white coat. It's much more accurate and reliable than any other technique in the office.

The American Society of Hypertension in their most recent guidelines together with the International Society of Hypertension recommended electronic devices, not to use the mercury sphygmomanometer. The U.S. Preventive Services Task Force has recommended not making a diagnosis based on office readings because they're talking about manual office readings.